Doctors and hospitals charge a fee to give Evusheld, the only drug that works to prevent Covid-19 for many immunocompromised people, even though the government distributes the drug for free.
Evusheld, a monoclonal antibody, is the only Covid prevention option for many people with weakened immune systems because vaccines failed to give them antibodies.
“It is completely unfair to have a public health policy that forces those most vulnerable to Covid to pay their own way for protective treatment,” said Art Caplan, director of medical ethics at the Grossman School of Medicine in NYU. “It makes no ethical sense.”
In a recording since removed from a federal government website, a health official said in February that officials knew patients were being charged large sums for monoclonal antibodies and that this violated the government’s goal of to have equitable access to Covid-19 medicines.
But officials have offered no plan, at least not publicly, to fix the situation, leaving some immunocompromised people in sticker shock when they go to the doctor to get Evusheld.
A patient from Fort Myers, Florida, said she was already spending hundreds of dollars a month on prescription drugs for her rare muscle disease and couldn’t afford the $520 it would cost her to get Evusheld, even with his health insurance. She never had the medicine.
She said she will “wait and hope I don’t get Covid and die”.
“Being hit by this bill was like a slap in the face,” she added. “It’s here, but we’ll charge you what we want. And there’s nothing you can do about it.”
A woman from Mission Viejo, Calif., said she paid $1,100 to get Evusheld, on top of what her insurance paid for.
“I called it opportunistic billing,” said the patient, who is immunocompromised due to medication she takes for a rare kidney disease. “I am grateful that my family can afford [it]. But my thoughts instantly went to – there’s a lot of families that couldn’t do that.”
A kidney transplant patient in Charlottesville, Va., said she had to pay over $400 to get Evusheld, and that was on top of the nearly $2,000 paid by her insurance. The drug requires a doctor’s prescription and, like the vaccine, is given in two injections, although for Evusheld both are given in one appointment.
“It’s a real slap in the face to be told, ‘Oh, we’ve got protection for you, but you better cough or you won’t get it at all,'” she said.
Several of the patients interviewed for this story requested anonymity lest their doctors retaliate against them for speaking publicly about their ordeals.
The US Department of Health and Human Services distributes Evusheld.
“COVID-19 therapies are provided free of charge to patients, however, patients may be charged an administration fee for monoclonal antibody treatments, including Evusheld, depending on their status or type of insurance,” according to an emailed statement from HHS spokesperson Jorge Silva.
Another HHS spokesperson, who asked not to be named, suggested that patients be charged high fees – they said “providers charging exorbitant fees during a public health emergency should be reported to their state medical board” and the health department.
The spokesperson did not explain why they wanted to remain anonymous.
Caplan, the ethicist, called the response “ridiculous”. “People need protection quickly, not protection after a two-month bureaucratic review,” he said. “That’s a miserable non-answer. It’s insufficient.”
“In violation of our planning priorities”
Government health officials have known for months that some patients have had to pay high prices for Evusheld.
“Obviously, that would be in violation of our planning priorities,” HHS physician Dr. Derek Eisnor said, according to Endpoints, “which again is to maintain equitable access to all purchased therapies for all Americans, regardless of their ability to pay.”
“They’re leaving that to the private market, which is what American health care is to most people,” said Michael Fraser, CEO of the Association of State and Territorial Health Officials. “What Dr Eisnor said about this breach of government planning priorities is correct, but it doesn’t change the situation for the patients who are being billed for it.”
Medicare and Medicaid patients do not have to pay any fees for Evusheld.
Dr. Dorry Segev, a transplant surgeon at NYU Langone Health and a leading researcher on the effectiveness of Covid-19 vaccines for the immunocompromised, asked if HHS could have made the Evusheld rules similar to the vaccine rules.
“I wonder if they could have required the insurance companies to cover it or the Covid emergency funds to cover it like they did for other treatments and vaccinations,” he said.
As it stands, vendors charge a fee to give away Evusheld because they can, he noted.
“People will gamble within the letter of the law often against the spirit of the law,” he said.
HHS spokespersons did not respond to CNN’s query regarding Segev’s comments.
Some patients have successfully negotiated better rates for Evusheld.
Michelle Fontenot, a kidney transplant patient in St. Charles, Illinois, said she argued with her health insurance company when she said she would have to pay $800 for Evusheld. After weeks of calls and emails, she says she finally didn’t have to pay anything.
“It just seems a little unfair that if you’re immunocompetent you can just walk into Walgreens and get your shots and sit there for 15 minutes and away you go,” Fontenot said, but if you’re immunocompromised, “you You’re being charged $800 for (Evusheld) just because your body didn’t respond to mRNA vaccines.That just doesn’t seem right.
Fontenot is a former insurance broker, and Segev noted that the system is set up to benefit patients like her who are particularly well-educated or savvy, which is at odds with the government’s goal of equitable access. .
“This is yet another example of the disparities that have emerged during the pandemic,” he said.
The Fort Myers woman with a rare muscle condition said she couldn’t find a way to avoid paying the $520 fee.
She has been essentially sequestered at home during the pandemic and has limited her children’s activities to reduce the risk of them contracting Covid and passing it on to her. She and her family were thrilled when her doctor said she could Evusheld.
“We told them there was a new drug that could help protect me [and] they were so excited they even clapped,” she said. “They got up and danced.”
Then she had to let her children, ages 7, 10 and 12, know that they couldn’t afford the $520 fee to get the drug.
“I can’t even express how frustrating it is — it’s beyond frustrating,” she said. “It’s infuriating. It angers me to know it’s there and it’s just out of reach.”